2.2 million Euros in two years spent by the European Commission to promote designated driver campaigns to combat drink driving is not value for money for European tax payers according to a new report on Drinking and Driving in Europe published by Eurocare.

Whilst such campaigns are appealing, they have little impact on improving road safety and reducing death and injury from alcohol related accidents.

The European Union has set a target of halving the number of people killed in road traffic accidents from the present 40,000 a year in the existing fifteen Member States. Available statistics indicate that at least 10,000 lives can be saved annually if drink driving was eliminated.

Dr Peter Anderson, the author of the Report, said:

"If the drink industry wishes to spend their money on designated driver campaigns so be it, but there is certainly no need for the European Commission to waste taxpayers money on them.

Eurocare makes the point that monies in the Commission's Drink Driving budget would be better spent on publicity campaigns promoting policy options which are effective such as lowering the legal limit, enforcing the legal limit and automatic disqualification of drivers. Promoting designated drink driving campaigns will make little, if any, dent in the direct costs of road traffic accidents which cost the EU over 45 million Euros.

DRINKING AND DRIVING IN EUROPE
A EUROCARE REPORT TO THE EU

The European Union has set itself a target of halving the number of people killed in road traffic accidents in the present fifteen countries of the Union. These deaths amounted to 40,000 a year between 2000 and 2010. The attention is to achieve this 50 per cent reduction by harmonization of penalties, and the promotion of new technologies to improve road safety. There is an even greater scope for improvement in the applicant countries, where the road infrastructure is less developed and where vehicles are less likely to be fitted with the latest safety technology. Nearly one third of the death and disability caused by motor vehicle accidents is due to alcohol; this can be substantially reduced by a more uniform and lower blood alcohol concentration limit, adequate enforcement through unrestricted powers to breath test, and automatic licence suspension when over the legal limit.

A common playing field should be provided for the road users of Europe, including professional drivers, with equal parity and without disadvantage across countries. Road users expect strict road safety measures and strict reductions in drinking and driving. They expect to be subjected to the lowest level of risk that is in operation throughout Europe. The following Eurocare recommendations aim to achieve a target of halving the deaths and disability adjusted life years due to drinking and driving between 2000 and 2010, aim to provide European road users with a consistent European platform on drinking and driving and aim to make European roads alcohol free.

Although the prevention of drinking-driving has been described as one of the public health success stories of the last quarter of the 20th century, the downward trends stabilized or increased at the end of the 1990s, and there is clearly considerable room for improvement.

Of all modes of transport, driving on roads is the most dangerous and the most costly in terms of human lives. Drivers in Europe expect stricter road safety measures, such as improved road quality, better training of drivers, enforcement of traffic regulations, checks on vehicle safety, road safety campaigns, and strict reductions in drinking and driving.

The most effective measures to reduce alcohol related road traffic accidents are lowering the legal level of blood alcohol concentration, supported by deterrence through unrestricted powers to breath test.

Lower legal levels of blood alcohol concentrations are effective for young and inexperienced drivers.

The Maastricht Treaty provided the European Union with the legal means to establish a framework and introduce measures in the field of road safety as well as obviating sources of danger to health, such as drinking and driving.

Although logically the legal drink driving limit should be zero, a concerted effort to reduce drink driving in the countries of the European Union based on a uniform blood alcohol concentration limit of 0.5g/L and of 0.2g/L for novice drivers and drivers of public service and heavy goods vehicles, supported by national enforcement and publicity, could reduce drink driving fatalities by at least 10 per cent, saving some 1,000 lives annually. Eventually, the limit should be reduced to 0.2g/L for all drivers.

Licence suspension and vehicle actions can be effective in reducing reoccurrence of alcohol related road traffic accidents, when combined with remedial programmes.

Comprehensive community based programmes that combine media campaigns, educational campaigns and responsible serving practices, although expensive, can lead to further reductions in drink driving fatalities.

Policies that reduce the availability of alcohol for example through price increases, and minimum legal drinking ages also reduce alcohol related road fatalities.

The least effective policies are those that attempt to separate drinking from driving through educational programmes alone, server interventions alone and alternative transportation programmes.

Eurocare's paper, makes the following recommendations:

1. A maximum blood alcohol concentration limit of 0.5 g/L (and breath equivalent) should be introduced throughout Europe with immediate effect; a lower limit of 0.2 g/L should be introduced for novice drivers and drivers of public service and heavy goods vehicles, with immediate effect; countries with existing lower levels should not increase them.

2. By the year 2010, the maximum blood alcohol concentration limit should be reduced to 0.2g/L for all drivers.

3. Unrestricted powers to breath test, using breathalysers of equivalent and agreed standard, should be implemented throughout Europe; 50 per cent of all European drivers should have been stopped and breath tested at some time by the year 2010.

4. Common penalties for drinking and driving, with clarity and swiftness of punishment, need to be introduced throughout Europe; penalties should be graded depending at least on the BAC level, and should include licence suspensions, fines, prison sentences, ignition locks and vehicle impoundment; all drivers on European roads with a BAC level greater than 0.5 g/L should have an unconditional licence suspension; based on the existing range of licence suspensions in European countries, Eurocare suggests a minimum suspension period of 6 months.

5. Driver education, rehabilitation and treatment schemes, linked to penalties, including the return of suspended licences, need to be strengthened and implemented throughout Europe for drinking and driving offenders, including those with evidence of dependence on alcohol, based on agreed evidence based guidelines and protocols.

6. Because of limited evidence for their effectiveness in reducing drinking and driving, public education efforts to persuade drinkers not to drive after drinking, programmes to encourage servers to prevent intoxicated individuals from driving, and organized efforts to make provisions for alternative transportation should not be the main cornerstones of drinking and driving policy.

7. Although the beverage alcohol industry has a responsibility in reducing drinking and driving, drink driving laws and regulations and public education campaigns should be set and implemented throughout Europe independent of the beverage alcohol industry.

8. Lowered blood alcohol concentration limits, the introduction of unrestricted powers to breath test and the introduction of common penalties, such as automatic licence suspension when over a limit of 0.5 g/l should be supported by major publicity campaigns to inform the drivers of Europe of the new measures.

9. A monitoring system, with common and standardized measures across European countries, should be put in place to produce annual reports on drinking and driving in Europe, the implementation of these recommendations, and on the progress to achieving a target of halving deaths and disability adjusted life years due to drinking and driving between 2000 and 2010.

The Eurocare report says:

Although the number of road accident deaths in the European Union dropped at the beginning of the 1990s, in recent years, the downward trend has stabilized. In the year 2000, road accidents killed over 40,000 people and injured more than 1.7 million in the fifteen countries of the existing Union. The age group most affected is the 14-25 year olds, for whom road accidents are the prime cause of death. One in three Europeans will be injured in a road traffic accident at some point in their lives. This directly costs the European Union 45 billion euros. Indirect costs (including physical and psychological damage suffered by the victims and their families) are three to four times higher. The annual figure is put at 160 billion euros, equivalent to 2 per cent of the Union's GNP.

The European Commission has estimated that one quarter of these deaths, 10000, are due to alcohol, at a cost of 40 billion euros per annum. This figure is likely to be an underestimate, since the global burden of disease study of the World Health Organization estimated in European countries that 45 per cent of the burden of disability arising from motor vehicle accidents for men and 18 per cent for women is attributable to alcohol. Between 1 per cent and 5 per cent of drivers have blood alcohol levels above their country's maximum limits, accounting for up to 20 per cent of fatal and serious injuries, and up to 25 per cent of driver fatalities. Fatal accidents involving large goods vehicles and buses account for about 18 per cent of all fatal accidents. Once involved in a road accident, large vehicles have the potential to cause severe property damage, disruption, delay, and traffic congestion especially in tunnels, on bridges, on main arterial roads, or in densely populated urban areas.

The lowering of the Blood Alcohol Concentration (BAC) level has been a contentious subject in some countries, such as the United Kingdom, where the Government has been reluctant to move on this despite assurances given before coming into power. In the report Dr Anderson argues forcefully for a lower level:

The risk of traffic accident increases exponentially with the BAC level. There is a 38 per cent increased risk of accidents at 0.5g/L and nearly 5 times the risk at 1.0g/L. Lowering BAC levels consistently produce less drinking and driving across all BAC concentrations and reduce alcohol-related road traffic accidents.

When Sweden lowered the BAC level from 0.5g/L to 0.2g/L in 1990 fatal alcohol-related accidents were reduced by 10 per cent. Similar experiences were found in Austria, Belgium and France following lowering of their BAC levels. Lower BAC limits for young drivers can reduce fatal crashes and injuries by up to one quarter.

A key target to reduce drink driving fatalities in Europe is to lower the legal maximum BAC limits and make these consistent across Europe. Of 29 Member States, applicant and EFTA-EEA countries, five have a legal limit of 0.8g/L, 17 a limit of 0.5G/L (including Lithuania with a level of 0.4g/L), two with a level of 0.2g/L and five with a level of zero (see Table 3 in technical section of document).

Logically the legal BAC limit (and breath equivalent) should be zero, which implies in practice a BAC measurement of between 0.1 g/L and 0.2 g/L, depending on the tolerance level that is allowed for. On the basis of accumulative research evidence and analysis, the maximum BAC limit of 0.5 g/L, which was first proposed by the European Commission in 1988, should be the recommended maximum legal limit within countries of the European Union. There should be a lower limit of 0.2 g/L for novice drivers and drivers of public service and heavy goods vehicles. Countries with existing lower levels should not increase them. Over time, the maximum BAC limit should be reduced to 0.2g/L for all drivers in all countries.

The main benefit of more uniform legal maximum BAC limits is to provide a clearer and more consistent message to all drivers of private cars and of passenger and freight vehicles that drinking and driving is a dangerous activity. From a driver perspective more uniform limits will also provide a standard reference for country based enforcement and Europe-wide publicity campaigns. Where drivers are driving within countries of the European Union, they should be aware of a uniform limit above which, if they are caught, they will know they have committed a drink driving offence.

Not only should BAC levels be reduced, but they also need to be consistently enforced, says the report:

Testing in connection with another motoring offence or selective testing based on drivers who have judged to have been drinking alcohol will miss most drivers who have BAC levels over the legal limit. Observation without the use of breathalyser equipment will miss at least one half of those with a BAC level greater than 1g/L.

Effective enforcement requires unrestricted powers for high visibility breath testing using breathalyser equipment of an agreed technical European standard.

The introduction of unrestricted breath testing is known to result in more than a 20 per cent reduction in fatal crashes.

The country with the most experience of unrestricted breath testing in the form of random breath testing is Australia. Motorists are stopped at random by police and required to take a preliminary breath test, even if they are not suspected of having committed an offence or been involved in an accident. The defining feature is that any motorist at any time may be required to take a test, and there is nothing that the driver can do to influence the chances of being tested. In 1999, 82 per cent of Australian motorists reported having been stopped at some time, compared with 16 per cent in, for example, the United Kingdom. The result was that fatal crash levels dropped by 22 per cent, while alcohol-involved traffic crashes dropped by 36 per cent. Random breath testing was twice as effective as selective checkpoints. For example, in Queensland, random breath testing resulted in a 35 per cent reduction in fatal accidents, compared with 15 per cent for selective checkpoints.

Drink driving laws must be publicized to be effective. If the public is unaware of a change in the law or an increase in its enforcement, it is unlikely that it will affect their drinking and driving. Studies in California demonstrated that publicity doubled the impact of new laws and new enforcement efforts to reduce drinking and driving.

In addition, the report suggests, there needs to be a common penalty for dinking and driving throughout Europe, graded depending on at least the BAC level:

Currently, there is a wide range of penalties in terms of length of maximum licence suspension, disqualifications and prison sentences. Penalties should include licence suspension, fines, prison sentences, ignition locks and vehicle impoundment. The key to effectiveness is clarity and swiftness of punishment.

Licence suspension can reduce fatal accidents by one quarter and can deter future offences. Although, without some form of education, counselling or treatment programme, the effects of suspension might last only as long as the period of suspension, which could be relatively short. All drivers on European roads with a BAC level greater than 0.5 g/L should have an unconditional licence suspension; based on the existing range of licence suspensions in European countries, Eurocare suggests a minimum suspension period of 6 months.

Prison sentences and fines provide a penalty for failure to conform to the probation requirements established by the courts and may provide the legal basis for referring offenders to treatment programmes, which have been shown to reduce future offences. Placing interlocks in the ignition to prevent an impaired driver from operating the vehicle can reduce drinking and driving, although usually only for the time that the interlock is in place. Interlocks can also be used as a preventive measure for drivers of public service and heavy goods vehicles. Impounding the offender's vehicle or removing the vehicle licence plate are effective in reducing future episodes of drinking and driving.

There is an important role, says Dr Anderson, for education, rehabilitation and treatment programmes across Europe:

Convicted drinking drivers represent a heterogeneous group. Some offenders can be classified as high-risk drivers who drink; others might be classified as problem drinkers who drive. Indeed, a large segment of the patient population being treated for alcohol dependence has entered treatment because of an alcohol-impaired driving conviction. Education, rehabilitation and treatment schemes can reduce both future drinking and driving offences and alcohol-related accidents by 8-9 per cent.

In the same way, brief treatments based in accident and emergency departments can be effective in reducing subsequent alcohol-related trauma and hospitalization, although the results tend to fall off over time. Driver education, rehabilitation and treatment schemes, linked to penalties, including the return of suspended licences, need to be strengthened and implemented throughout Europe for drinking and driving offenders, including those with evidence of dependence on alcohol, based on agreed evidence based guidelines and protocols.

Some measures favoured by governments are of limited effectiveness, the report claims:

Public education efforts to persuade drinkers not to drink before driving and not to drive after drinking, programmes to encourage servers to prevent intoxicated individuals from driving, and organized efforts to make provisions for alternative transportation, whilst all appealing, have been found to have only limited effectiveness and should not be the main cornerstones of drinking and driving policy.

Server training programmes, which attempt to prevent drinking and driving by identifying intoxication and refusing service, have not been found to be successful on their own in reducing drink driving. However, when backed up by civil liability for subsequent alcohol related traffic accidents, they can be effective in reducing drinking and driving.

There has been very little evaluation of designated driver programmes. The information that is available would suggest that they are not as effective as a measure to prevent alcohol-impaired driving as originally envisioned, and there is no evidence to date that they lead to a reduction in drinking and driving.

Nor, according to the report, are the alcohol industry's efforts any more likely to prove an answer to the drink driving problem:

Although the beverage alcohol industry has a responsibility in reducing drinking and driving, the policy measures supported by the beverage alcohol industry (public education efforts to persuade drinkers not to drive after drinking, programmes to encourage servers to prevent intoxicated individuals from driving, and organized efforts to make provisions for alternative transportation) tend to be those with the least evidence for effectiveness in reducing drinking and driving .

Whereas those policy options (lowering of legal blood alcohol concentration levels, introduction of unrestricted or random breath testing, and the introduction of alcohol policy measures, such as increased taxation or restrictions on legal drinking ages) with the best evidence for effectiveness in reducing drinking and driving tend to be opposed by the beverage alcohol industry. Further, there is concern that designated driver campaigns have been and can be used by the beverage alcohol industry as a vehicle to market their own products, confusing the public and losing the credibility of the campaigns, which become perceived as a direct activity of the beverage alcohol industry. Thus drink driving laws and regulations and public education campaigns should be set and implemented throughout Europe independent of the beverage alcohol industry.

The Eurocare report suggests the ambitious target of halving the deaths and disability adjusted life years due to drinking and driving in Europe between 2000 and 2010:

A monitoring system, with common and agreed measurement and reporting procedures across European countries, should be put in place. Annual reports should be published on drinking and driving in Europe, describing the implementation of any new measures and monitoring the progress to achieving the target of halving drink driving related deaths and disabilities.